1. Pharmacoeconomics and Outcomes Research Dean G. Smith, Ph.D. October 10, 2005 UM Student Chapter

2. Senior Associate Dean for Administration Professor of Health Management & Policy Disclosure

3. Prescription Drug “Inflation”

4. Co-Director, Michigan-Pfizer Pharmacoeconomics & Outcomes Research Fellowship Program http://www.sph.umich.edu/hmp/admissions/pdfellowship.html Disclosure

5. The mission of ISPOR is to translate pharmacoeconomics and outcomes research into practice to ensure that society allocates scarce health care resources wisely, fairly, and efficiently.

6. Further reading …

7. Designed specifically to meet the clinical informational needs of managed care's Pharmacy and Therapeutics Committee Members. Editors: Michael E. Chernew, Ph.D. A. Mark Fendrick, MD

8. Distribution of Hypercholesterolemia - US 28% Am J Cardiol 1998;82:61-5. 52% 31% 17%

9. Lovastatin (generic) $0.62 Lovastatin (Mevacor) $1.28 Fluvastatin (Lescol 20) $1.67 Atorvastatin (Lipitor) $2.18 $2.03 Simvastatin (Zocor) $2.29 $2.13 Rosuvastatin (Crestor) $2.42 $2.31 Pravastatin (Pravacol) $2.67 $2.57 Online prices in the US: 10 mg, 90 tablets drugstore.com June 1, 2005, Medi-Span March 31, 2005 Drug Prices

10. Some prices may change  Zocor - 2006  Pravacol - 2006  Lipitor - 2011  Crestor - 2016 Current analyses might think about future prices Hamilton DP, Winslow R. Do statins help prevent cancer? Few tests slated. Wall Street Journal May 20, 2005, B1. B3.

11. Member, Pharmacy Benefit Oversight Committee Formulary: http://www.umich.edu/~benefits/plans/ drugs/formulary.htm Disclosure

12. Tier 1 $7 Lovastatin (generic) Tier 2 $14 Atorvastatin (Lipitor) Pravastatin (Pravacol) Rosuvastatin (Crestor) Ezetimibe/Simvastatin (Vytorin) Niacin/Lovastatin (Advicor) Tier 3 $24 Lovastatin (Mevacor/Altoprev) Fluvastatin (Lescol/Lescol XL) Simvastatin (Zocor) U Michigan Formulary

13. “The mean statin copayment had a large effect on compliance. If the copayment increases by $15, the probability of compliance decreases by 10 percentage points.”  Doesn’t account for the process that might occur with selection of a Tier 2 or Tier 3 agent. Pharmaceutical Economics Schultz, O’Donnell et al. Determinants of compliance with statin therapy and LDL-C goal attainment in a managed care setting. American Journal of Managed Care, May 2005.

14. Member, Board of Directors Michigan New Health Plan Formulary: http://www.molinahealthcare.com/ michigan/provider/formulary.html Disclosure

15. Standard Lovastatin (generic) Lovastatin (Altoprev) Atorvastatin (Lipitor 10 mg, 20 mg) Ezetimibe/Simvastatin (Vytorin) Prior Authorization Atorvastatin (Lipitor 40 mg, 80 mg) Molina Michigan Formulary

16. HOWEVER, price is not value Claiming value requires a comparison of costs and benefits  Some purchasers care about value, others only price per pill  If you care about value, then there's the short-run LDL-C change or guidelines/goals and the long-run mortality/QALY Drug Therapy

17. Week % Responders 1224364854 0 10 20 30 40 50 60 70 80 90 Atorvastatin Fluvastatin Pravastatin Simvastatin Cumulative Responders

18. * Total Cost to LDL-C Target * p < 0.01 vs. others Smith, McBurney. An Economic Analysis of The Atorvastatin Comparative Cholesterol Efficacy and Safety Study (ACCESS). Pharmacoeconomics, 2003.

19. Willingness-to-Pay (NCEP) Miller, Smith, Jones. Cost Effectiveness of Rosuvastatin in Treating Patients to Low-Density Lipoprotein Cholesterol Goals Compared With Atorvastatin, Pravastatin, and Simvastatin (a US Analysis of the STELLAR Trial). American Journal of Cardiology, 2005.

21. Questions ?